H-K-M Services
107-40 Queens Blvd.
Room 205
Forest Hills, NY 11375

Job Requisition Form
   First Name *  Last Name *

Phone Number* Cell Phone

Email Address (Please fill so we can reply to your request)

Full Address *

Required Work :
(Please list type of work requested, i.e.: light housekeeping, heavy housekeeping,
companion,live-in nurse, etc.)

I am agreeing to pay the employee :
PER : (Please choose one)

H-K-M Services

  Additional Info :

How did you hear about us?

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